scholarly journals Validity of the Dynamic Gait Index in People With Multiple Sclerosis

2013 ◽  
Vol 93 (10) ◽  
pp. 1369-1376 ◽  
Author(s):  
Anette Forsberg ◽  
Malin Andreasson ◽  
Ylva E. Nilsagård
Keyword(s):  
Multiple Sclerosis ◽  
At Risk ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Cutoff Point ◽  
Walk Test ◽  
Impact Scale ◽  
Risk Of Falls ◽  
Dynamic Gait Index ◽  
Dynamic Gait

BackgroundEvaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying people at risk for falls needs to be further investigated.ObjectiveThe objective of this study was to investigate (1) the construct validity (known groups, convergent, and discriminant) of the DGI and (2) the accuracy of predicting falls and establishing a cutoff point to identify fallers.DesignThis trial was a multicenter, cross-sectional study.MethodsA convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m (comparable to Expanded Disability Status Scale 1–6). Mean age of the participants was 49 years; 76% were women. The 25-Foot Timed Walk Test, Timed “Up & Go” Test, Four Square Step Test, Timed Sit-to-Stand Test, MS Walking Scale, Multiple Sclerosis Impact Scale, and self-reported falls during the previous 2 months were used for validation, to establish cutoff points for identifying fallers, and to investigate predictive values.ResultsSignificantly lower DGI scores (P≤.001) were found for participants reporting falls (n=31). High sensitivity (87%) in identifying fallers was found, with a cutoff score ≤19. The positive predictive value was 50%, and the negative predictive value was 87%. The positive likelihood ratio was 1.77, and the negative likelihood ratio was 0.26. The convergent validity was moderate to strong (ρ=0.58–0.80), with the highest correlation coefficient found for the 25-Foot Timed Walk Test. Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale.LimitationsThe sample included ambulatory people participating in a randomized controlled trial investigating balance training.ConclusionsThe DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis. With the cutoff point of ≤19, sensitivity was high in identifying people at risk of falls.

scholarly journals Effects of Fatigue on Balance and Mobility in Subjects with Multiple Sclerosis: A Brief Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Elisa Gervasoni ◽  
Davide Cattaneo ◽  
Angelo Montesano ◽  
Johanna Jonsdottir
Keyword(s):  
Multiple Sclerosis ◽  
Berg Balance Scale ◽  
Balance Performance ◽  
Before And After ◽  
Increase Risk ◽  
Risk Of Falls ◽  
Edss Score ◽  
The Difference ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Purpose. People with Multiple Sclerosis (PwMS) tent to have increased levels of fatigue which can impact on their balance and increase risk of falls. However, the relationship between fatigue and balance is poorly understood. The aim of the present study was to assess if an experimentally induced fatigue had an immediate effect on balance. Methods. 37 inpatients with multiple sclerosis were recruited; the mean age (standard deviation) was 48.7 (9.6) years. The average onset of the pathology was 15.3 (9.8) years before the start of the study. The median (1°–3° quartile) Expanded Disability Status Scale (EDSS) score was 5.5 (4.5–6.0). Before and after a fatiguing treadmill, session, subjects were assessed with the Berg Balance Scale and Dynamic Gait Index. Results. After the treadmill, no statistically significant differences were found in balance before and after a treadmill session (monopodalic stance: before 5.3s (10.3) and after 7.7s (13.9); walk with horizontal head turns: before 11.6 (6.9) seconds and after 11.3 (7.7)). There was no correlation between the EDSS score and the difference in balance skills before and after treadmill. Conclusion. After treadmil PwMS were mentally and physically fatigued; however, their balance performance did not change, indicating no increase in risk of falling with fatigue.

Identification of modified dynamic gait index cutoff scores for assessing fall risk in people with Parkinson disease, stroke and multiple sclerosis

2022 ◽  
Vol 91 ◽  
pp. 1-6
Author(s):  
Alessandro Torchio ◽  
Chiara Corrini ◽  
Denise Anastasi ◽  
Riccardo Parelli ◽  
Matteo Meotti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson Disease ◽  
Fall Risk ◽  
Cutoff Scores ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

scholarly journals Effects of application of texture insoles on the balance of subjects with Multiple Sclerosis

2017 ◽  
Vol 16 (1) ◽  
pp. 9-16
Author(s):  
Wildja De Lima Gomes ◽  
Thais Botossi Scalha ◽  
Lucas Brino Mota ◽  
Viviane Almeida Kuroda ◽  
Juliana Cintra Garrafa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Dynamic Balance ◽  
Step Length ◽  
Berg Balance Scale ◽  
Measuring Instruments ◽  
Balance Scale ◽  
Functional Gait ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Objective: The aim of this study was to evaluate the effects on static and dynamic balance after the use of textured insoles. Method: Fifteen subjects with multiple sclerosis were evaluated before using the insoles, after using them for 1 month, and after 2 months without using, them using the following measuring instruments: the Berg Balance Scale, Dynamic Gait Index, and 10-meter Walk Test, a means of functional gait assessment. Results: Improvement was observed in the Berg Balance Scale and Dynamic Gait Index scores, walking time, number of steps and step length after using the insoles for 1 month. The improvement in Berg Balance Scale score remained after two months without the insoles and there were no changes in gait speed. Conclusion: The use of textured insoles was effective as an intervention to improve static and dynamic balance in patients with multiple sclerosis.

scholarly journals A disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in patients with multiple sclerosis

2016 ◽  
Vol 74 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Bruna Antinori Vignola da Fonseca ◽  
Cristiana Borges Pereira ◽  
Frederico Jorge ◽  
Renata Simm ◽  
Samira Apostolos-Pereira ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Balance Disorders ◽  
Visual Vertical ◽  
Perception Of Verticality ◽  
Risk Of Fall ◽  
Multiple Sclerosis Patients ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
The Relationship ◽  
Gait Index

ABSTRACT The purpose of this study was to determine the relationship between perception of verticality and balance disorders in multiple sclerosis patients. We evaluated patients and healthy controls. Patients were divided into two groups according to their risk of fall, with or without risk of fall, measured by a Dynamic Gait Index scale. Graviceptive perception was assessed using the subjective visual vertical test. Patients with risk of fall showed worse perception than those without risk of fall, p < 0.001. Misperception of verticality was correlated with the dynamic gait index scores (p < 0.001), suggesting that the larger the error for verticality judgment, the greater risk for falling. Considering that the perception of verticality is essential for postural control, our results suggested that the disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in these patients.

scholarly journals Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 27 ◽  
Author(s):  
Tapan Mehta ◽  
Hui-Ju Young ◽  
Byron Lai ◽  
Fuchenchu Wang ◽  
Yumi Kim ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lower Extremity ◽  
Physical Functioning ◽  
Concurrent Validity ◽  
Convergent Validity ◽  
Dynamic Balance ◽  
Berg Balance Scale ◽  
Sf 36 ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Background: Recent clinical guidelines for adults with neurological disabilities suggest the need to assess measures of static and dynamic balance using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) as core outcome measures. Given that the BBS measures both static and dynamic balance, it was unclear as to whether either of these instruments was superior in terms of its convergent and concurrent validity, and whether there was value in complementing the BBS with the DGI. Objective: The objective was to evaluate the concurrent and convergent validity of the BBS and DGI by comparing the performance of these two functional balance tests in people with multiple sclerosis (MS). Methods: Baseline cross-sectional data on 75 people with MS were collected for use in this study from 14 physical therapy clinics participating in a large pragmatic cluster-randomized trial. Convergent validity estimates between the DGI and BBS were examined by comparing the partial Spearman correlations of each test to objective lower extremity functional measures (Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Timed 25-Foot Walk (T25FW) test) and the self-reported outcomes of physical functioning and general health using the 36-Item Short Form Health Survey (SF-36). Concurrent validity was assessed by applying logistic regression with gait disability as the binary outcome (Patient Determined Disease Steps (PDDS) as the criterion measure). The predictive ability of two models, a reduced/parsimonious model including the BBS only and a second model including both the BBS and DGI, were compared using the adjusted coefficient of determinations. Results: Both the DGI and BBS were strongly correlated with lower extremity measures overall as well as across the two PDSS strata with correlations. In PDDS ≤ 2, the difference in the convergence of BBS with TUG and DGI with TUG was −0.123 (95% CI: −0.280, −0.012). While this finding was statistically significant at a type 1 error rate of 0.05, it was not significant (Hommel’s adjusted p-value = 0.465) after accounting for multiple testing corrections to control for the family-wise error rate. The BBS–SF-36 physical functioning correlation was at least moderate and significant overall and across both PDDS strata. However, the DGI–physical functioning score did not have a statistically significant correlation within PDDS ≤ 2. None of the differences in convergent and concurrent validity between the BBS and DGI were significant. The additional variation in 6MWT explained by the DGI when added to a model with the BBS was 7.78% (95% CI: 0.6%, 15%). Conclusions: These exploratory analyses on data collected in pragmatic real-world settings suggest that neither of these measures of balance is profoundly superior to the other in terms of its concurrent and convergent validity. The DGI may not have any utility for people with PDDS ≤ 2, especially if the focus is on mobility, but may be useful if the goal is to provide insight on lower extremity endurance. Further research leveraging longitudinal data from pragmatic trials and quasi-experimental designs may provide more information about the clinical usefulness of the DGI in terms of its predictive validity when compared to the BBS.

Toward a Consensus on Rehabilitation Outcomes in MS: Gait and Fatigue

2009 ◽  
Vol 11 (2) ◽  
pp. 67-78 ◽  
Author(s):  
Brian Hutchinson ◽  
Susan J. Forwell ◽  
Susan Bennett ◽  
Theodore Brown ◽  
Herb Karpatkin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Consensus Conference ◽  
Timed Up And Go ◽  
Assessment Battery ◽  
Rehabilitation Professionals ◽  
Rehabilitation Outcomes ◽  
Dynamic Gait Index ◽  
Dynamic Gait

A multidisciplinary consensus conference was held on November 28–29, 2007, by the Consortium of Multiple Sclerosis Centers (CMSC) to determine the most appropriate outcome measures for gait and fatigue in people with multiple sclerosis (MS). The goals of this conference were to 1) improve understanding of gait and fatigue outcome measures being used by rehabilitation professionals treating people with MS; 2) establish consensus on outcome measures; and 3) establish consensus on required follow-up for transfer of this knowledge to rehabilitation professionals. The consensus conference and this document are the initial steps toward achieving the stated goals. Although many measures of fatigue exist, it was recommended that a global outcome measure for fatigue be developed that would 1) include a screen for the functional ramifications of fatigue for activities and participation; 2) be quick and easy to administer; 3) demonstrate psychometric integrity for MS; and 4) examine fatigue over a continuum of the MS disease course. In addition, it was recommended that an assessment battery for fatigue be developed. With respect to gait outcome measures, it was agreed that the following tools should be included in a preliminary chart for use in a clinical setting: the Timed 25-Foot Walk, Timed Up and Go test, Dynamic Gait Index, 6-Minute Walk, and self-reported 12-item Multiple Sclerosis Walking Scale. The global outcome fatigue measure and assessment battery are currently being developed, and work on a detailed gait outcome measures chart and additional research on commonly used gait outcome measures are in progress.

Disability Prediction by Early Hammersmith Neonatal Neurological Examination: A Diagnostic Study

2020 ◽  
Vol 35 (11) ◽  
pp. 731-736
Author(s):  
Sujith Kumar Reddy Gurram Venkata ◽  
Femitha Pournami ◽  
Jyothi Prabhakar ◽  
Anand Nandakumar ◽  
Naveen Jain
Keyword(s):  
At Risk ◽  
Likelihood Ratio ◽  
Preterm Infants ◽  
Predictive Value ◽  
Current Trend ◽  
Positive Likelihood Ratio ◽  
Predictive Ability ◽  
Diagnostic Study ◽  
Term Neonates ◽  
Neurodevelopmental Disability

Background and Objectives: Hammersmith Neonatal Neurologic Examination (HNNE) is used to identify term and preterm infants at risk of neurodevelopmental disability. The test is recommended at corrected term age in preterm; and around 2 weeks postnatal age in term neonates. As the current trend is to discharge based on physiological stability, it may not be feasible to perform HNNE at recommended age. The authors investigated whether predictive ability of the test for neurodevelopmental disability remained unchanged if performed early (before discharge). Methods: The authors enrolled preterm and at-risk term neonates. HNNE PE was performed before discharge in all infants. The test was repeated in preterm infants at 40 weeks postmenstrual age and in term neonates at 2 weeks of age (HNNE RA). Neurodevelopmental disability was assessed at 1 year of age. Results: HNNE PE was done in 125 neonates (103 preterm, 22 term neonates). HNNE RA was done in 58% infants. Neurodevelopmental disability was assessed in 84 (67%) of infants. Neurodevelopmental disability was noted in 14/84 (16.6%) babies. The receiver operating characteristic curve of raw scores showed that area under the curve for HNNE PE (0.71) and HNNE RA (0.66) were similar. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for both the tests were similar for a cutoff optimality score of 32.5. HNNE PE could be performed up to 4 weeks earlier than HNNE RA with the same predictive ability for neurodevelopmental disability. Conclusions: HNNE PE was as reliable as HNNE RA in predicting neurodevelopmental disability at 1 year of age. Completion of the test is assured and provides several weeks lead time for early intervention.

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